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A comparison of mdma-assisted psychotherapy to non-assisted psychotherapy in treatment-resistant PTSD: A systematic review and meta-analysis

Published online by Cambridge University Press:  13 August 2021

B. Illingworth ,
D. Lewis ,
A. Lambarth ,
K. Stocking ,
J. Duffy ,
L. Jelen  and
J. Rucker
B. Illingworth*
Affiliation:
Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
D. Lewis
Affiliation:
Acute Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
A. Lambarth
Affiliation:
Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
K. Stocking
Affiliation:
Centre For Biostatistics, University of Manchester, Manchester, United Kingdom
J. Duffy
Affiliation:
Institute For Women’s Health, University College London, London, United Kingdom
L. Jelen
Affiliation:
Centre For Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
J. Rucker
Affiliation:
Centre For Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

Novel, evidence-based treatments are required for treatment-resistant post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine (MDMA) has beneficially augmented psychotherapy in several small clinical trials.

Objectives

To review the use of MDMA-assisted psychotherapy in treatment-resistant PTSD.

Methods

Systematic searches of four databases were conducted from inception to February 2020. A meta-analysis was performed on trials which were double-blinded, randomised, and compared MDMA-assisted psychotherapy to psychotherapy and placebo. The primary outcomes were the differences in Clinician Administered PTSD Scale (CAPS-IV) score and Beck’s Depression Inventory (BDI). Secondary outcome measures included neurocognitive and physical adverse effects, at the time, and within seven days of intervention.

Results

Four randomised controlled trials (RCTs) met inclusion criteria. When compared to active placebo, intervention groups taking 75mg (MD -46.90; 95% CI -58.78, -35.02), 125mg (MD -20.98; 95% CI -34.35, -7.61) but not 100mg (MD -12.90; 95% CI -36.09, 10.29) of MDMA with psychotherapy, had significant decreases in CAPS-IV scores, as did the inactive placebo arm (MD -33.20; 95% CI -40.53, -25.87). A significant decrease in BDI when compared to active placebo (MD -10.80; 95% CI -20.39, -1.21) was only observed at 75mg. Compared to placebo, participants reported significantly more episodes of low mood, nausea and jaw-clenching during sessions and lack of appetite after seven days.

Conclusions

These results demonstrate potential therapeutic benefit with minimal physical and neurocognitive risk for the use of MDMA-assisted psychotherapy in TR-PTSD, despite little effect on Beck’s Depression Inventory. Better powered RCTs are required to investigate further.

Disclosure

James Rucker has attended trial related meetings paid for by Compass Pathways Ltd.

Keywords

MDMAptsdTreatment-resistancepsychotherapy
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S141 - S142
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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